MEDICARE: DANDELION THERAPEUTIC ART CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1992342422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANDELION THERAPEUTIC ART CENTER

Provider Business Mailing Address
First Line	:	1628 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1214
Country	:	US
Telephone Number	:	847-651-8643
Fax Number	:

Provider Business Practice Location Address
First Line	:	1628 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1214
Country	:	US
Telephone Number	:	847-651-8643
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. CAROLINE TYE
Credential	:	LCPC, ATR-BC
Telephone Number	:	847-651-8643

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	03/25/2024

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